An important study published in Pediatrics1 indicated that over 17.5 million (or 1 in 4) school-aged children in the United States have been exposed to weapon violence in their lifetime, as either witnesses or victims. The results also suggest that more than 2 million (1 in 33) children have been directly assaulted with lethal weapons, including guns and knives.

The data was collected as part of the National Survey of Children’s Exposure to Violence. The sample (N = 4114) was a nationally represented survey conducted in 2011 of children (51% boys, 56.7% Caucasian, 18.8% Latino, 15.1% Black, and 9.4 Another Non-Latino Race) between the ages of two and seventeen years.

According to the authors, children’s exposure to violence is a primary national healthcare crisis, even greater than pediatric diabetes or cancer. The American Academy of Pediatrics2 suggests an even higher concern, stating that gun violence is the second leading cause of death for children in the United States. Data from the National Center for Health Statistics3 supports these concerns, indicating that firearms are in the top 10 leading causes of injury deaths for children as young as 1 year old.

The Brady Campaign4 also reports staggering statistics, including a daily average of 40 children and teens being shot and surviving, American children being killed by gun violence 11 times more often than children in other high-income countries, and the incidence of over 160 school shootings since the Sandy Hook mass shooting in 2012.

The medical, psychological, and economic cost of these statistics are profound, but frequently neglected or unknown. It is estimated that homicide- and assault-related injuries cost the US $16 million annually.1 Being a victim, a victim of multiple incidents (poly-victim), or even a witness of violence results in significant levels of symptoms of trauma, depression, anxiety, anger, and aggression in youth.1,5 The authors report that children exposed to lethal weapon violence, such as a knife or gun crime, were significantly more likely to report these symptoms than children who had not been exposed to such weapon violence, even after taking into consideration and removing the variables of physical abuse, sexual abuse, and neglect that are also associated with trauma symptoms.

It is important to note that research indicates that witnessing violence is also a significant risk factor, and is often more frightening to children.6 Moreover, high lethality risk weapon violence is a greater contributing factor to trauma symptoms, even more than that of multiple victimization incidents.1

The incidence, prevalence, and research indicate that weapon violence is frighteningly high in the United States, and a substantial number of children may be at risk for significant mental health issues. Yet, program development and implementation focused on intervention and prevention related to the consequences of weapon violence are sparse and often unavailable to communities who need it most. It is imperative that we focus our resources on what is being defined by experts as a “national youth crisis” in delivering cost-effective, immediate, and community-based mental health programs to children exposed to weapon violence.

Although it may take years to diminish the prevalence of weapon violence in the US, simple therapeutic tools may be the first step for immediate intervention. One such resource is a new book, Where Did My Friend Go? Helping Children Cope With A Traumatic Death that can serve as an excellent first step in the journey of healing. Where Did My Friend Go? is a children’s picture book for therapeutic coping that is to be read by an adult to a young child (3–8 years) who has witnessed or survived a traumatic death.

The purpose of the book is to facilitate the child’s processing and coping with the fear, loss, and confusion associated with the trauma in developmentally appropriate and safe ways. Thorough guides for adults and child-based interventions are provided at the beginning and end of the book. The book is versatile and can be utilized for incidents of gun violence, other-weapon violence, terrorist attacks, car accidents, and plane crashes.

Parents, teachers, pediatricians, ER doctors, counselors, and social workers in schools, shelters, community clinics, and hospitals, who are the first to observe socio-emotional and physical symptoms in children, can use Where Did My Friend Go? as a first step assessment and intervention tool. The professionals on the front lines working with affected children need to be proactive in asking children about their exposure to weapon violence, and this book can serve as a helpful resource in the process. The play-based interventions at the end of the book are also an effective guide for parents and professionals on how to explore, shift, and reassure young children’s trauma, anxiety, and loss to more adaptive functioning.

Mental health professionals need to begin to develop and deliver intervention and prevention programs in schools, clinics, and shelters for the staggering number of children and teenagers exposed to lethal weapon violence. Teachers and healthcare professionals can play a critical role in identifying victims of violence and making appropriate referrals. Establishing and implementing standardized screenings for exposure to lethal weapon violence for children and teenagers as part of a general well-visit exam at the pediatrician’s, as well as in all schools, Head Starts, ERs, and shelters may further allow us to intervene at the early stages of symptom presentation.

As we well know, violence begets violence. Early intervention is prevention, and if one in four American children are being directly exposed to weapon violence, we need to step in now to break the intergenerational cycle of violence and the emerging mental health crisis related to trauma and weapon violence.

Azmaira Maker, PhD, is a licensed clinical psychologist who received her Bachelor’s Degree in Psychology from Vassar College (Phi Beta Kappa), and her doctoral training at University of Michigan, Ann Arbor. She completed her post-doctoral fellowship training at University of Michigan Hospital, Department of Psychiatry. Her expertise lies in trauma, loss, child development, parenting, and psychotherapy, and she has over twenty years of experience working with children and families in hospitals, schools, clinical agencies, and non-profit organizations. Her extensive experience working with trauma, along with her training at the Child Advocacy Clinic at the University of Michigan Law School, provides her with extensive clinical skills and expert knowledge that guide the content of her books. She also has significant experience teaching and supervising graduate and undergraduate students in play therapy, family therapy, and parent guidance. Dr. Maker has published research and theoretical articles in scientific, peer reviewed professional psychology journals. She currently resides in San Diego where she has a private practice, and works as a consultant and presenter, and on her other books on IVF, pregnancy loss, and celebrating differences.

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